12 Ways to Reduce Hospital Readmissions

With hospital readmission rates as high one in five nationwide, we asked experts for tips on getting those numbers down. Some strategies aren't yet proven, but many providers are experimenting with anything that sounds plausible.

10 comments on "12 Ways to Reduce Hospital Readmissions"
Rick Bloemen (10/1/2012 at 11:52 AM)

I agree with Charlene Perrone and her comments that a big piece of the puzzle is during the discharge process. How much real information and true guidance are the families getting. Should they just be discharged to go home? Do they need in-home care to help monitor and administer care? Should they be sent to assisted living and if so, which one ? I have seen the practice over and over where a family is given "The Blue Book" and left to their own resources. And then we all wonder why there is a recurring readmission rate.In our business, we are a placement agency, we visit and rate the homes, work with in-home care agencies, meet and spend hours of time with the families doing assessments for care and budgets and then we tour the family to the different homes, to match the patient with the right care. Case managers do not have the time or resources to know which particular home would be the right choice. They do not visit each home and see the layouts for handicap accessability and function, diet control etc. I ask the question as did Charlene Parrone, that has an in-home care company, why not get out of the box and use other professionals to help? There are ways of screening out the non-legitimate companies. And I ask, what is better The system we have that is failing or to try a new approach? Or do we continue just handing out "The Blue Book" closing our eyes and hope that it works this time.
Charlene Perrone (8/2/2012 at 8:53 PM)

I find that there's something missing in our discussion regarding reducing hospital readmissions, and that's the non-medical home care component. Health Plans, hospitals, even physicians are looking for strategies to reduce readmission rates including hiring hospitalists, additional social workers, and nurses. But no-one is talking about the most cost-effective way to discharge patients appropriately and assist them in recuperating at home. Non-medical home care companies like mine have skilled, experienced caregivers who are well-versed in the discharge process, understand medications and dme, are able to monitor vital signs once the patient is home and under periodic home health care, and can support the patient every step of the way in his or her recuperation...at home. Home Instead Senior Care has even developed its own "hospital-to-home" evidence-based program called Returning Home, which is proven to have helped Medicare patients avoid hospital readmission within that critical 30-day period. The program includes a strategy for tracking patients so that hospitals and home health agencies can understand and improve the benefits of this vital collaboration. I realize that the low-income and minority populations are most at risk for hospital readmissions, and clearly that's a problem when it comes to non-medical home care, because right now the only way to cover our service is through private pay, long-term care insurance or veterans' benefits. That's why health care facilities and insurance plans need to be creative...and understand how important a piece of this collaborative puzzle we are. They need to figure out a way to commission or contract with companies like mine to assist their patients at discharge. As an example, a hospital or health plan might think of partnering with a legitimate company or group of companies like mine and paying for a certain number of hours with their patients to make sure the discharge papers are in order, that all dme is ordered, that a home health agency has been prescribed, and then to transport them, to make sure all meds are in place, to ensure they have adequate food and supplies, and to do follow-up to make sure the patient is following all discharge orders. Working together, we can reduce significantly the number of hospital readmissions; I know this for a fact. I just don't know if anyone in the health care industry is listening. C. Perrone
Janet Thurston MSN (1/21/2012 at 8:20 PM)

Everything written creates a safer, better experience for all patients. With this information now coming into realization, why is it so difficult to do? ie Pts go home with their meds understanding them, Dr follow up appts arranged. Pt questions answered. Why would a pt have to pay 100$ for a copy of their medical record? This is another shame. Dr to Dr / free Dr to Pt / fee
Todd Madden (1/4/2012 at 5:12 PM)

Computerized Physician Order Entry is another way to reduce a hospital error and thus reduce the chance of readmission. Unforatunately too few hospitals in the US use it.
Lorree Bell, R.N., HCS-D, COS-C (1/4/2011 at 4:44 PM)

You can reduce hospital readmissions by partnering with a good Home Health provider. They will reconcile the medications, assess for risk factors, and implement interventions to keep the patient out of the hospital. Particularly during the first 30 days when they are at the greatest risk.
Marita Florini FNP-BC (1/2/2011 at 6:39 PM)

Very interesting article. However, the medication reconcilliation also begins in the primary care office. It must be recognized that the likelihood of it being 100%correct is probably less than 0. However, communicate with your in home people, and have folks get used to a health care diary that lists there history and medications.
Kristin Baird, RN, BSN, MHA (12/28/2010 at 4:36 PM)

Great article Cheryl. There are lots of good suggestions here. I would also include the need to manage the discharge information throughout the entire stay so that the patient isn't overwhelmed or bombarded at the 11th hour. The post discharge phone call is also crucial for managing adverse reactions early and also for encouraging timely follow up. One other observation-I find it interesting that most of the states with the highest readmission rates also score poorly on HCAHPS.
Steve Wilkins (12/27/2010 at 12:22 PM)

Good article. But I would emphasize one key area that being the need to get the discahrged patient back in the primary care physician's office for immediate follow up. The first call the telehealth nurse shuld make is to the patient's PCP to noftify of the hospitalization/discharge and to arrange for someone to contact the patinet/caregivers to get the patient into the physician office...or better yet the doctor into the patient's home. Better communication is a simple and inexpensive solution! Steve Wilkins www.healthecommunications.wordpress.com
Robert Stone (12/27/2010 at 10:21 AM)

These are all excellent strategies for reducing the number of readmissions, but it seems to me, given the incredibly high number of avoidable admissions, that the best strategy would be to avoid the first admission in the fist place.
A. J. Rosmarin (12/27/2010 at 9:40 AM)

Be proactive about infection control during the hospital stay. The cost of a readmission or extended stay due to a patient contracting a pathogen from the OR or patient room such as MRSA can approach $100,000 or more and significantly extend the stay or result in an unpplanned readmission.Check out www.xenex.com, a company on the forefront of providing technology to deal with infection control.


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